To summarize perioperative nursing care in a case with acute left heart failure caused by giant ball thrombus blocking micro orifice in left atrium. The nursing points are as follows：quickly improving pre-operative preparations,activating the emergency team of the cardiac special bank,and preparing equipment and items;during the operation,rapidly establishing extracorporeal circulation,strengthening the blood management,carrying out the phased temperature management,conducting active blood sugar management and clustered surgical infection management;management and psychological care of post-complication. The patient was well rehabilitated and discharged from the hospital 27 days after surgery.